check($_POST["captcha_code"]) == false) { // the code was incorrect // you should handle the error so that the form processor doesn't continue $error = "The security code entered was incorrect.

"; } else { $error = ""; } } ?> Service Agreement Price Request - ABC Office
Home > Service Agreement Price Request

Service Agreement Price Request

 
We Accept Company and Government Purchase Orders!

Required fields are in red
 
Name
" size="35" maxlength="40" />
Email
" size="35" maxlength="40" />
Address
" size="35" maxlength="40" />
Address Line 2
" size="35" maxlength="40" />
City
" size="35" maxlength="40" />
State
" size="12" maxlength="40" />
Zip/Postal Code
" size="12" maxlength="40" />
companyany
" size="35" maxlength="40" />
Phone
" size="35" maxlength="40" />
Comments
Join E-mail List.
CAPTCHA Image

Enter code from above:
No Image Available